GIANT SOFT TISSUE SARCOMA: A CASE REPORT

Case: Male, 48 years old, with progressive growth lesion in the adductor region of the left thigh, associated with local pain on exertion for 6 months. No risk factors or personal cancer history, neoplastic family history (mother died of lung cancer). On examination: large mass occupying the entire medial and partial compartment of the posterior region of the left thigh. Brought CT of the lower limbs presenting in MIE heterogeneous expansive lesion, with ill-defined limits, contrast-capturing with necrotic areas of permeability measuring about 16.7 × 10.2 × 11.0 cm (L × AP ×T), estimated volume of 974.3 cm3, involving the adductor magnus muscle in the posteromedial face of the left thigh, suspected for neoplasia in the left adductor muscle. Therefore, was decided to perform resection of this tumor with myocutaneous flap reconstruction. Thus, the entire medial compartment was excised + partial resection of the vastus medialis muscle + myocutaneous flap reconstruction + left thigh inguinal lymphadenectomy. The femoral and deep femoral vascular nerve bundles + sciatic nerve were in close contact with the tumor, having been dissected in all its extensions. Discussion: Soft tissue sarcomas (STS) are rare malignant tumors that arise from extra-skeletal connective tissues, including the peripheral nervous system. They are more common in extremities, especially lower limbs, and can occur anywhere. Its objective treatment: long-term survival, avoid local recurrence, maximize function and minimize morbidity. Surgical excision is potentially curative and diagnostic (through histopathology). In almost all patients with tumors larger than 5 cm, the addition of radiotherapy optimizes local control and increases the chances of limb preservation. Most STSs have a <5% risk of lymph node metastases, with the exception of synovial and vascular sarcomas, rhabdomyosarcomas, epithelioid and clear cell subtypes (higher risk of nodal metastasis). In most cases, regardless of the type of histological tumor, regional lymph node dissection is recommended in case of clinical or radiological evidence of regional lymphadenomegaly. Final comments: This case is noteworthy and interesting for the record, due to the large size of the tumor, which already caused functional damage to the patient, as well as the relative complexity involved in the surgical procedure, as well as the rarity of the STS.

Publication History

Article published online:
23 October 2019